Multiple sclerosis (MS) is an immune-mediated condition that affects the central nervous system (CNS). Experts aren’t exactly sure what causes it, but they know that the immune system is involved.
With MS, your immune system mistakenly attacks your nerves and destroys myelin, their protective coating.
If left untreated, MS can eventually destroy all the myelin surrounding your nerves. After that, it may start to harm the nerves themselves.
There’s no cure for MS, but there are several types of treatments.
In some cases, treatment can slow the pace of MS. Treatment can also help ease symptoms and reduce potential damage done by MS flare-ups. Flare-ups are the periods when you have symptoms.
If attacks happen often, you may need a type of medication called a disease modifier. Disease modifiers can change how the disease behaves. They can also help slow the progression of MS and reduce flare-ups.
Some disease-modifying therapies come as infused medications. These infusion treatments may be especially helpful to people with aggressive or advanced MS.
Read on to learn more about these medications and how they help treat MS.
Q:
How are infusion treatments given?
Anonymous readerA:
Infusion treatments are delivered slowly through a needle, typically into a vein. These treatments are administered by a healthcare professional in a clinical setting, like an infusion center, or sometimes in the comfort of the person’s home. Because the treatment is going directly into the bloodstream, people receiving infusions will usually be monitored by a healthcare professional while they are getting the treatment.
Alexandra Perez, PharmD, MBA, BCGPAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.Today there are four infusible disease-modifying drugs approved by the Food and Drug Administration (FDA) to treat MS.
Alemtuzumab (Lemtrada)
Doctors give alemtuzumab (Lemtrada) to people who haven’t responded well to at least one other MS medication.
This drug works by slowly reducing your body’s number of B and T lymphocytes, which are types of white blood cells (WBCs). This action may reduce inflammation and damage to nerve cells.
You receive this drug once per day for 5 days. Then, 1 year after your first treatment, you receive the drug once per day for 3 days.
Natalizumab (Tysabri)
Natalizumab (Tysabri) works by stopping the damaging immune cells from entering your brain and spinal cord. You receive this drug once every 4 weeks.
Mitoxantrone
Mitoxantrone is an MS infusion treatment as well as a chemotherapy drug used to help treat cancer.
It may work best for people with secondary progressive MS (SPMS) or rapidly worsening MS.
That’s because it’s an immunosuppressant, which means it works to stop your immune system’s reaction to MS attacks. This effect can reduce the symptoms of an MS flare-up.
You receive this drug once every 3 months for a lifetime maximum cumulative dose of 140 milligrams per square meter (mg/m2). This dose will likely be reached within 2 to 3 years.
Because of the risk of serious side effects, mitoxantrone is only recommended for people with severe MS.
Ocrelizumab (Ocrevus)
Ocrelizumab is the newest infusion treatment for MS. It was approved by the FDA in 2017.
Ocrelizumab is used to treat relapsing or primary progressive forms of MS. In fact, it’s the first drug approved to treat primary progressive MS (PPMS).
This medication is thought to work by targeting the B lymphocytes that are responsible for myelin sheath damage and repair.
It’s initially given in two 300-milligram infusions, separated by 2 weeks. After that, it’s given in 600-milligram infusions every 6 months.
The infusion process itself can cause side effects, which may include:
- bruising or bleeding at the injection site
- flushing, or the reddening and warming of your skin
- chills
- nausea
You can also have an infusion reaction. This is a drug reaction on your skin.
For all these drugs, an infusion reaction is more likely to occur within the first 2 hours of administration. However, it’s also possible for a reaction to occur up to 24 hours later.
Symptoms can include:
- hives
- scaly patches on your skin
- warmness or fever
- rash
Each infused drug has its own possible side effects.
Alemtuzumab
The more common side effects of this drug can include:
- rash
- headache
- fever
- common cold
- nausea
- urinary tract infection (UTI)
- fatigue
This drug can also cause very serious — and potentially fatal — side effects. These can include:
- autoimmune reactions, such as Guillain-Barré syndrome and organ failure
- cancer
- blood disorders
Natalizumab
The more common side effects of this drug can include:
- infections
- allergic reactions
- headache
- fatigue
- depression
Serious side effects can include:
- a rare and deadly brain infection called progressive multifocal leukoencephalopathy (PML)
- liver problems, with symptoms such as:
- yellowing of your skin or the whites of your eyes
- dark or brown (tea-colored) urine
- pain in the upper right side of your abdomen
- bleeding or bruising that occurs more easily than normal
- tiredness
Mitoxantrone
The more common side effects of this drug can include:
- low WBC levels, which may increase your risk of infections
- depression
- bone pain
- nausea or vomiting
- hair loss
- UTI
- amenorrhea, or a lack of menstrual periods
- blue-green urine
- mouth sores
Serious side effects can include:
- congestive heart failure
- kidney failure
- blood issues
Receiving too much of this drug puts you at risk for serious side effects that can be very toxic to your body, like the ones listed above. For this reason, mitoxantrone should only be used in severe MS cases.
Your doctor will watch you very closely for signs of side effects during treatment with this drug.
Ocrelizumab
The more common side effects of this drug can include:
- infections
- infusion reactions
Serious side effects can include:
- PML
- reactivation of hepatitis B or shingles, if they’re already in your system
- a weakened immune system
- cancer, including breast cancer
Other infusion treatments
In some cases, your doctor may suggest infusion treatments that don’t also function as disease-modifying drugs for MS. They include:
- Plasmapheresis. Plasmapheresis involves removing blood from your body, filtering it to remove antibodies that may be attacking your nervous system, and sending the “cleansed” blood back into your body through a transfusion.
- Intravenous immunoglobulin (IVIG). In IVIG therapy, you receive blood plasma donations from people without immune conditions. This transfusion helps boost your own immune system.
- Rituximab (Rituxan). This treatment works by targeting white blood cells known as B lymphocytes. It’s traditionally used to help treat conditions such as rheumatoid arthritis, non-Hodgkin’s lymphoma, and chronic lymphocytic leukemia.
- Methylprednisolone (Solu-Medrol). Methylprednisolone is a potent anti-inflammatory steroid. Like other steroids for MS, it works by helping to prevent inflammatory cells from crossing into the CNS.
Infusion treatments can be a good option to help treat MS symptoms and flare-ups.
However, these drugs aren’t right for everyone. They carry risks of rare but serious complications.
Still, many people have found them helpful.
If you have progressive MS or are looking for a better way to manage your symptoms, ask your doctor about infusion treatments. Your doctor can help you decide if these drugs might be a good choice for you.